“Collaborative nurse–physician relationships…lead to better patient and organizational outcomes such as decreased length of stay and net reduction in treatment costs without reduction in functional levels or decrease in satisfaction among patients,” Claudia Schmalenberg, RN, MSN, and Marlene Kramer, RN, PhD, wrote in a 2009 article for Critical Care Nurse. “In addition to patient outcomes, high-quality nurse–physician relations result in increased satisfaction among nurses and physicians and increased autonomy for nurses.”

The benefits of team training

The emphasis on team training in health care is a positive development, said Suzanne Gordon, an expert on health care communications issues and the author of First Do Less Harm: Confronting Inconvenient Problems in Patient Safety.

Team training helps people from various backgrounds and disciplines become more familiar with each other and their particular roles and skills. When health care professionals are accustomed to collaborating, they are less likely to feel and act like they are in competition with each other.

“Each health care profession has information the other needs to possess in order to practice successfully,” wrote Linda Lindeke, PhD, RN, CNP, and Ann Sieckert, BAN, in a 2005 article for the Online Journal of Issues in Nursing. “In the interest of safe patient care, neither profession can stand alone, making good collaboration skills essential.”

That doesn’t mean, of course, that all the old barriers have just disappeared. Some old habits--holdovers from an era when the hierarchical model, with the physician at the top, was paramount--take a while to die out. Plus, some organizations may have been more successful at creating a team environment than others. But institutions must commit to team training--and continue to educate their staffs on a regular basis, Gordon said.

“Ultimately, people have to be team trained,” she said. “That’s the only way to get to safety.”

What nurses can do

Want to develop and maintain good working relationships with physicians in your workplace? Try these seven steps:

1. Take pride in your practice. Show up on time, pay attention to details and do the absolute best that you can. Such professionalism leaves little room for complaints and can build respect.

2. Communicate effectively. Research has shown that some physicians express frustration with nurses who don’t communicate information in an organized, logical and concise manner. Learn to communicate information clearly and efficiently, without a lot of extraneous detail, especially in emergency situations. Some hospitals and organizations have instituted standardized communication tools to bridge the gaps that often exist between people with different communication styles, which can also be helpful.

3. Embrace the team approach. Everyone on your team, not just the physician, has an important role to play. Approach the situation as a collaboration, one in which you are just as responsible for the patient as the physician. “Don’t refer to someone as ‘your patient,’” said Gordon. “It’s ‘our patient.’”

4. Speak up when you notice a problem or a potential error. You can do this calmly and carefully, but you must not be afraid to speak up. “You cannot claim to be a professional and a patient advocate if you won’t speak up if you see something that’s wrong,” Gordon said. “Don’t let patients die because you are afraid to speak up.”

5. Avoid negative behaviors. If you want to be respected, you must act worthy of that respect. You don’t want to be the kind of person that people interact one time and then never want to see again, noted Lindeke. One strategy that she and Sieckert reference in their OJIN article was to avoid blaming others for problems that exist in nursing; “It is counterproductive and unprofessional to blame physicians, administrators, organizations or other nurses for the frustrating and disappointing aspects of present-day nursing,” they wrote. “Acting like an oppressed group will not encourage others to respect and trust nurses.”

6. Consider the context. Health care is fraught with stressful situations, which can lead to a physician or another clinician saying something that is unintentionally hurtful. It can be helpful to consider the context of the situation, and not just the literal words that were spoken, before reacting or responding, Lindeke said. It may also be helpful to consider the personality of the other person involved and approach the situation accordingly.

7. Have a sense of humor. That doesn’t mean joking around on the job. But there are times that humor can help reframe a situation or diffuse a tense moment, said Lindeke. “Sometimes you can get your message through with humor, too,” she added.

A nurse’s personal efforts can go a long way toward improving nurse–physician relationships, but there are certainly some institutional hurdles that can still exist. As Gordon noted, it’s not helpful for an organization to encourage nurses to speak up about potential errors or problems if the culture also allows physicians to react by blowing up or lashing out in anger because they feel insulted.

“If your institution won’t back you up, that’s a problem,” she said. “That’s an institutional problem.”

Another important point to consider is that nurses’ interactions are constantly being observed by others. You may be working with new nurses, residents or other new hires; if so, you’ll want to be a good example for them, so they know what good working relationships look like and how they function. Patients watch how nurses interact with their medical colleagues, too.

“You’re always role modeling, and you can’t forget that,” said Lindeke.